Month: April 2016

This past October 31 marked the first time I dressed up for Halloween in over half a decade. For years I had avoided dressing up and declined my friends’ Halloween party invitations because I could not tolerate the way that a costume would draw more attention to my physical appearance. I wanted my female face and female body to remain as invisible as possible. But thanks to my workouts and weight loss and more frequent male pronouns from strangers, I finally felt physically comfortable enough to consider a Halloween costume. When my manager encouraged employees to dress up at work, I wanted, for once, to be a good sport and join the fun instead of hiding behind lame excuses for my lack of Halloween spirit.

So I called my sister from a dollar store the day before Halloween, needing her help to navigate the dizzying rainbow array of pretty paints and powders. This was the first time I had ever worn real makeup and I had no idea what I was doing. “So you’ll probably want to go for the pencil eyeliner, it’s easier to work with than the liquid brush which can get kinda messy if you don’t have a lot of practice… but maybe get both and see which one you like better?” she said. She doesn’t wear cosmetics on a regular basis, but she has a lot of practice doing stage makeup from her days in ballet and cheerleading. “And you should probably get some lip liner to give your lips a defined outline, especially if you’re going with cheap lipstick which tends to smear.” All excellent advice. $15 and a few hours later, she coached me through my clumsy first attempts at applying all these products. My face was raw and red from rubbing off all my mistakes. But if I was going to dress in drag – compared to my usual androgynous attire, wearing makeup and a tight T-shirt and a short skirt seemed as deliberately flamboyant and exaggeratedly feminine as drag costumes – well, I was damn well going to do a good job of it.

Despite the frustration of several failed attempts, I ended up enjoying the process of painting my face. As an artist (many years ago), black was always my favorite color. Black – pure, plain, unadulterated black – is dull and flat and lifeless. But black enhanced with hints of othercolors – it becomes an enchanting dark dimension. So in my artwork, black was never just black. And on my face it was the same, purples and reds blending beautifully into the black eyeshadow and black lipstick.

The fact that I had so much fun with my costume was unexpected. Also unexpected was the way this makeup mask made my mirror image temporarily comfortable. Usually when I catch a glimpse of my face in a mirror, a flash of unsettling unfamiliarity floods those first few moments. But with such ostentatious makeup, that feeling of detachment from my own reflection suddenly had a perfectly coherent explanation, which made me feel strangely comfortable with the unfamiliarity of that painted face staring back at me.

“A large rose tree stood near the entrance of the garden: the roses growing on it were white, but there were three gardeners at it, busily painting them red.”– Lewis Carroll (Alice’s Adventures in Wonderland, 1865)

As I get closer to my appointment to start hormone therapy, I have been forced to confront one of my biggest fears regarding testosterone: hair loss, also known as male-pattern baldness or androgenetic alopecia. I have been reluctant to admit this fear of hair loss, even to myself, because it seems like such a minor and superficial concern compared to so many other aspects of hormone therapy and gender dysphoria. I have been uncomfortable accepting that this fear is largely driven by vanity. I would like to think I am above such petty obsession with external appearance. But the intensity of my fear of hair loss suggests otherwise. So I have investigated strategies to prevent – or at least minimize – the extent of hair loss while taking testosterone.

Androgenetic alopecia affects approximately 50% of cisgender men by age 50 and approximately 90% of cisgender men in their lifetime (Kabir 2013). One study demonstrated that among Caucasian cisgender men, androgenetic alopecia was present in approximately 50% of those 30-35 years old, 60% of those 36-40 years old, and 70% of those 40-45 years old (Shankar 2009).Androgenetic alopecia is less prevalent, but still relatively common, among cisgender men of other ethnicities (Feinstein 2015). Men with visible hair loss are perceived as older and less physically and socially attractive (Mella 2010). The prevalence of androgenetic alopecia in female-to-male transpeople (FTMs) is similar to that for cisgender men, occurring in approximately 50% of FTMs after 13 years on a physiologic dose of testosterone (Fabris 2015, Gooren 2008, Meriggiola 2015).

Androgenetic alopecia is influenced by hormonal factors. Testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase. DHT has five times greater affinity for androgen receptors than testosterone. Hair follicles in the scalp produce 5-alpha-reductase which converts testosterone (produced elsewhere in the body) into DHT (which acts locally in the scalp). When DHT binds to androgen receptors on hair follicles, it results in a shortened anagen phase (the phase of hair growth) and decreases hair follicle size. This ultimately results in follicular miniaturization and the growth of shorter, thinner hair shafts. As more and more follicles undergo miniaturization, hair coverage of the scalp progressively decreases (Kabir 2013). Genetic factors also play a role. Androgenetic alopecia seems to be highly heritable, with complex polygenic inheritance and variable penetrance. Hair loss is more extensive in men with a genetic predisposition for greater numbers of androgen receptors on hair follicles and/or increased sensitivity of follicles to the effects of DHT (Kabir 2013).

One strategy to minimize hair loss that has been mentioned occasionally in articles about testosterone therapy is concurrent administration of finasteride. Finasteride selectively inhibits the 5-alpha-reductase enzyme, which decreases the concentration of DHT in the scalp and in the blood by approximately 60-70%. Because it reduces the amount of DHT, finasteride prevents or reverses hair follicle miniaturization as demonstrated in scalp biopsy studies (Mella 2010). Finasteride can be taken orally at a recommended dose of 1mg/day; studies have not demonstrated greater improvement in hair growth at higher doses (Mella 2010). Reported side effects of finasteride in cisgender men include decreased libido, erectile dysfunction, and ejaculation dysfunction; all of these side effects are very rare (Mella 2010). Presumably, erectile and ejaculation dysfunction would be of little concern in transgender men, even those who have had phalloplasty (given the current anatomical limitations of that surgery). Side effects of finasteride that are relevant for transmen include slowed or decreased growth of facial hair and body hair, and slowed or decreased clitoromegaly (TransHealth UCSF 2016). The blog American Trans Man has a post describing finasteride in more detail (Beards, Baldness and What’s in Your Pants).

Since I was a small child, my hair has been the source of great pride for me and much friction between my mother and I. For years I begged her to let me cut it short, but she refused on the grounds that it would make me “look like a boy.” She didn’t seem to understand that looking like a boy was precisely what I wanted. When she finally and reluctantly relented in 2006 and allowed my 14 year old self to get a short haircut, my hair became one of the first and one of the most important ways for me to exert some small measure of independence from my parents. Now that I am 24, my haircut is one of the only healthy ways I can modify my body and create a more masculine physical appearance to ease chronic physical dysphoria. (Obsessive exercise, excessive dietary restriction, self-induced vomiting, and painfully tight clothing are other strategies that I rely on to maintain a sufficiently masculine appearance but obviously I do not recommend these strategies).

For me, short hair is not just about gendered physical appearance. It is also about practicality. I hated long hair! I hated having to wash all that hair every evening in the shower. I hated having to towel-dry the soggy dripping mass. I hated how it took so long and hurt so much to comb out all the knots. I hated the way long tendrils of hair would end up everywhere – everywhere! – coiled in the shower drain, stretched out on my pillow, draped across my keyboard, poking out between the pages of a textbook like a tiny thready bookmark. I hated putting my hair in a ponytail, always conscious of the irritating tension, unsettled by how the sleek flatness of the pulled-back hair left my face so stark and open, like a picture without a frame. But I also hated leaving my hair free from the ponytail elastic, when it became a heavy hanging curtain that obscured my view and insisted on creeping into the corners of my mouth, my hands perpetually occupied in batting it away.

When I got it cut short, all those long-hair annoyances vanished. Then the only problem was that to maintain a shorter style, haircuts become necessary more frequently. The one advantage of long hair was that I only needed a haircut once or twice a year. My short style required a trim every eight weeks. I hated haircuts. I hated the inconvenience of having to schedule an appointment or waiting as a walk-in with nothing to do but browse through battered People magazines. I hated that I always gave the stylists the same description of what I wanted and got different cut every time.

I scrupulously avoided developing a long-term relationship with any of my hairdressers, taking pains to visit different salons on a rotating basis. Because once you’re beholden to one particular stylist then that’s it for you! No longer are you free to walk in whenever you choose – you have to make an appointment that works with their schedule, which is a chafing restriction of freedom for a busy person. No longer are you free to fend off small talk – you have to engage cheerfully and energetically to preserve this superficial relationship on good terms. After all, they are wielding sharp instruments in the vicinity of your jugular veins. No longer are you free to tip according to the quality of service – you now feel compelled to tip extra to ensure ongoing consistency in the style they deliver, tip extra to appear appreciative that they remember the random details of your life that they’ve extracted from you during reluctant small talk.

How I hated salon small talk! My silent salon-chair prayer: I’m paying you to cut not talk, so please, leave me be, focus on my hair, I don’t have anything to say. But stylists are relentless conversationalists, far more skilled in the art of superficial niceties than my awkward introverted self, leaving me always feeling two steps behind in a complicated and unwanted dance. “Ohmygod, has anyone told you how much you look like Miley Cyrus?” No. No, they haven’t. But we’re both female-bodied and we both have short hair so yeah, we’re, like, totally twins. Please. Do shut up. “So do you have any plans for the weekend, hon?” No. Well yes, but not plans I want to share with you. “Are you planning any fun vacations this summer, sweetheart? Gonna travel somewhere nice?” No. I don’t take vacations and I don’t travel. And if I say so, this is just going to get more awkward. “Are you excited for grad? Have you picked out your prom dress yet? You must be so excited!” No. I graduated from high school eight years ago and when I did, I wore pants. And, worst of all, “So where do you work?” Usually I avoided that question by being deliberately vague. But if, caught off guard and overwhelmed by social anxiety, I admitted the truth – that I recently graduated from veterinary school – I would inevitably hear about her friend’s cousin’s English Bulldog – or maybe she’s a French Bulldog? you know I never can remember the difference, dear – anyway, she has terrible dermatitis and do you think it could be a food allergy and should he try feeding her a strict diet of carrots and cottage cheese?

What I hate most of all – with a cold, hard, brittle anger – is the fact that women’s cuts cost more than men’s cuts irrespective of style and complexity. This is true even at bargain hair salons (Ultracuts: women’s cut $17.95, men’s cut $15.95), with the price differences exaggerated in higher-end salons (Euphoria: women’s cut $35-55, men’s cut $30-35). What epic bullshit this is! Not only is this pricing unfair and discriminatory, it is completely ridiculous considering that many women’s haircuts require little more than snipping a half-inch off the ends while men’s haircuts typically involve more extensive shaping and require the use of multiple tools (scissors, clippers, texturizers).

With all of these frustrations, the hair salon ordeal eventually became untenable. So I finally tried – with excitement and trepidation – to cut my hair myself. It was awkward and slow at first, trying to align the movements of my hands with the reverse image in the mirror, trimming conservatively in case of mistakes, making a hairy mess all over the bathroom counter. But I my system perfected now: #3 clipper guard (3/8 inch) on the sides, #4 guard (1/2 inch) to taper the sides into the top, scissor cut the top and bangs with practiced precision… and then the back, usually a #6 guard (3/4 inch) to leave it long enough to create a wide fauxhawk, but sometimes I let the back grow out for a few months into a baby rat tail (my dad says this looks like a mullet – business in the front, party in the back – but I say it’s a party in the front AND a party in the back).

I love cutting my hair. I love the feeling of accomplishment and competence when I see the finished product – damn girl, you did that! I love how it looks exactly as I had envisioned. I love the way the messy locks have a cocky character all their own, the way they frame my face in a way that feels so right. I love having the freedom to give myself a trim as soon my hair crosses my threshold of intolerable shagginess. I love the way the clippers feel moving across my scalp, the way the soothing vibration seems to penetrate all the way through to my brain. I love the way it feels when clumps of hair – spiky little dark brown mice – drop from the clipper blades onto my bare shoulders. I don’t even mind sweeping up these scattered clumps with my hands, flushing them down the toilet, vacuuming the bathroom afterwards. And I love how my mother hates my haircut. Perfect.

It is tempting to romanticize my hairstyle preference as an essential means of expressing some intransigent gender identity. I could perhaps pretend that my gender-non-conforming haircut has some important political significance, that it is a follicular feminist statement. If it were any of these things, my fear of hair loss would have a lovely self-righteous justification. But if I’m honest, I’d say my hair has no real significance beyond this simple fact: I love it. I love how it looks. I adore the feeling of my fingers running through the fresh-buzzed stubble. I enjoy the way the wind chills my exposed ears and naked nape, the way the breeze ruffles the hair on top like a friendly hand. If this is vanity, then fine – I’ll own that. I am vain. We all are, in different ways for different reasons. So I will explore the option of finasteride with an authentic shameless vanity.

Remembering and sequencing the events of today becomes an overwhelming challenge, my mind trudging grudgingly through the heavy fog that clouds those recent memories. The last few days and weeks and even years are stacked haphazardly, an inseparable scatter of all things past.

More cruelly, depression amputates the future. Tomorrow and next year are equally incomprehensible. This missing sense of future is deeply unsettling. It is like losing your peripheral vision – only when it’s gone do you realize, with horror! – how casually you took it for granted, how much it used to guide your behavior and perception, and how without out it you feel lost in a narrow and distorted world.

I have also seen these wrinkles in time described by people with terminal physical illnesses. Most eloquent of these descriptions was written by Paul Kalanithi in the days leading up to his death from lung cancer:

“Verb conjugation became muddled. What tense was I living in? The future tense seemed vacant and, on others’ lips, jarring. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.”

The relentless suicidal ideation that accompanies depression seems, in many ways, very similar to the last months of a fatal physical disease. To outsiders, the most salient difference between those two is the illusion of choice.

I think that a coherent sense of future can also be a casualty of gender dysphoria, especially for those of us with uncertain transition goals and unpredictable transition outcomes.

“I have had a hard time visualizing my future, as either female-perceived or male-perceived. Needless to say, this is a bit of a dilemma, as it can create the sense of moving into an enigmatic, inconceivable oblivion. Now, I don’t think it’s healthy to focus too much on the future, but I do think it’s normal to have some sort of future projection of yourself to hold onto – and I think that’s something that transgender people are plagued with – with not being able to visualize their future self during uncertain times, particularly when they are considering medical intervention.” – gendermagik

The point where depression and dysphoria intersect is a terrifying discontinuation of the mental and the physical, an inescapable Möbius strip of mind and body locked perpetually in the painful present tense.

The broken clock is a comfort, it helps me sleep tonight Maybe it can stop tomorrow from stealing all my timeI am here still waiting, though I still have my doubts I am damaged at best, like you’ve already figured out – Lifehouse (Broken, 2007)

“You do not get the time back. Whatever time is eaten by a depression is gone forever. No matter how bad you feel, you have to do everything you can to keep living, even if all you can do for the moment is to breathe. Wait it out and occupy the time of waiting as fully as you possibly can. Hold on to time.” – Andrew Solomon (The Noonday Demon, 2001)

I had been dealing with depression for several years before I started exploring gender transition options. Of course, the distressing incongruity between my female body and my brain’s non-female body map had been extreme and persistent since puberty, but I tried so hard for so long to suppress those feelings, to attribute them to the body image disturbances that characterize anorexia nervosa or dismiss them as an unusual form of gender-centered vanity. So it was not until more recently – thanks in large part to perceptive suggestions from an observant friend – that I learned about gender dysphoria and started considering transition in a personal context.

When I first became aware of these options, I felt an immediate and expansive euphoria, an ebullient optimism that inflated me with such promising possibility. I believed that I had finally found The Answer to so many of my life’s uncertainties. I believed that transitioning – in a straightforward black-and-white line, from ugly A to perfect B, from female to male (whatever I thought those words meant then) – was The Solution that would fix all of my problems.

Buoyed by this excitement I began researching transition options, poring obsessively over online trans forums and frantically downloading research papers from PubMed. Very quickly I encountered cautionary statements – in scientific studies and trans peoples’ own stories – urging those of us considering transition to have realistic expectations about how transition may affect our life and reminding us that transitioning will not solve every problem.

“Overall, participants’ evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. It was described as a ‘‘challenge’’ or a ‘‘long and difficult road’’ that was worth taking because of its positive implications on future life, at the end of which not everything was different or better without limitations.” (Rupin 2015)

“Don’t expect transitioning to solve all of your problems. Transitioning is not a panacea – it won’t solve all of your problems. If you were prone to anxiety before coming out, you’ll probably still have to deal with it afterwards. At some point in my transition, I came to terms with the fact that living as my true gender wouldn’t magically fix everything. And it felt really good to let go of that impossible expectation.” – Annika

So I started to examine my own expectations about transitioning. This process began very gradually, my original optimism tempered but preserved. But as I delved ever deeper into myself, as I came to recognize – with a terrifying emptiness – that I do not have any cognitive sense of gender identity (just the physical distress associated with female anatomy), and as my long-standing depression spiralled ever further out of control, I started asking myself with a haunting and repetitive urgency: how much does gender dysphoria contribute to my depression? How much can I expect transitioning to alleviate this complex distress? These questions quickly gathered a frightening momentum, eliminating one by one every hopeful expectation I had about transition, culminating in a crushing avalanche of doubt about whether my gender dysphoria was even worthy of continued acknowledgment.

So often I would reach the end of the day and reflect on the past 16 hours, wondering what would have been better if I had lived the day inside a male body. Usually the answer that I gave myself was that very little would have changed, perhaps a few accidental mirror glimpses – always that initial flash of confusion as my brain works to reconcile reality with expectation – those mirror glimpses might have been less unpleasant, sure, but nothing else would have been any better. So why bother with transition then? Why bother with all this gender nonsense at all?

But in the moments when depression loosens – ever so slightly – its death-grip on my mind, in the moments when I feel a lucid clarity open up like a window to the world, I wonder if perhaps I underestimate how deep this dysphoria extends, if I underestimate how extensively the brain numbs itself to daily pain after a lifetime of unabated agony. And in these moments I can relive the day with more precision, sailing through the same sequence of events, but this time in a masculine vessel. It seems a lot would have been better.

On the squash court –
The squeak and shriek of sneakers on shiny varnished floor –
I could have worn shorts without feeling so self-conscious of my girl hips, I would not have been so painfully aware of my small shoulders dwarfed by the broad backs of male opponents, I would not have felt such desperate pressure to overcompensate with wins to prove that I deserve to play among men.

Standing outside in the summer sun –
The far-off chirp of cheerful birds and the low buzz buzz of busy bees –
I could have escaped my sweat-sticky sweater, an all-season mask concealing the feminine swell of my chest, and I could have instead felt the sun kiss the skin on my bare arms, I could have let my eyes wander as they wished without so consciously averting my gaze from the girl-shaped shadow on the ground.

In the shower –
Warm rivulets of water draining down over all the parts that I pretend do not exist –
I would not have had to cloak myself in darkness, I could have soaped my bristly legs without thinking automatically that I should shave them, and stepping out afterwards I could have wrapped the towel around my waist and seen my face and my bare chest in the mirror and not had to look away.

Driving in my car –
My hand on the shift stick and wind breezing in through the open window –
I would not have had to angle the rearview mirror just so to avoid that quarter-slice of girl-face when I glanced upwards, I would not have had to tug my jacket down low enough to hide the width of my hips in the seat, and I could have sung along more freely with the radio with a deeper voice vibrating through the lines of my jaw.

Pulling on my pants in the morning –
The rustling of fabric and the brisk zip of the fly in chilly pre-dawn dimness –
The flatness of the crotch would not have been such a mocking emptiness, the snugness of the pants over my hips and thighs would not have been such an excruciating reminder, and when I looked down I would have seen a man in jeans instead of a girl in men’s jeans.

Sitting typing like I am now –
Quiet clickety clack, clickety clack, rat a tat tat –
I would not have to feel the tight X of bra straps across my back, I would not have to notice how my wrists and fingers on the keyboard seem so slight and feminine, and I would not have to be afraid of seeing my face reflected back at me in the laptop screen.

With all of that, how is it possible that I still doubt whether I should transition? Such doubt this is! It only seems to multiply as my mind paces the same well-worn path through the same worn-out questions. This doubt is an aggressive beast that feasts on self-reflection.

“Do you suppose,” the Walrus said,“That they could get it clear?”“I doubt it,” said the Carpenter,And shed a bitter tear.– Tweedledee (Through the Looking Glass and What Alice Found There, 1871)

I recently spent three weeks hospitalized in a psychiatric unit for treatment of depression. In clinical terms, I have severe chronic treatment-resistant major depressive disorder, a mouthful of words to describe a debilitating disease that has affected the trajectory of my entire adult life. My pharmaceutical history reads like a drug compendium, A to Z by generic name: aripiprazole, bupropion, caffeine, citalopram, clonazepam, desvenlafaxine, dexamphetamine, lisdexamphetamine, lorazepam, mirtazapine, oxazepam, trazodone, tryptophan, venlafaxine, vortioxetine, zolpidem, zopiclone. Over the past year in therapy, I have turned my soul inside out looking for answers, finding only a buzzing hive of angry stinging questions. But effort means nothing in the face of this monster. My brain just keeps attacking itself over and over, with ever shorter reprieves between recurrent nightmare episodes.

My time in hospital was frustrating, necessary, and marginally helpful. I worked hard to create realistic expectations for myself after discharge and I was prepared to tolerate the distress arising during the initial readjustment to real life. But coming home from hospital has been unlike anything I have ever experienced before… I feel empty, hollow, completely gutted, broken beyond repair with a skull full of ugly scars, so far beyond hopeless that there are no words to describe this degree of detachment and despair. Since then I have been going through the motions of daily life, but that is truly all they are – mechanical motions performed perfunctorily to pass the time. I still adhere to the hospital schedule because it is the only structure I can cling to in the shattered remnants of my world: breakfast at 8:00, lunch at 12:00, dinner at 17:00, one pill at 19:30, another at 21:00. And when I’ve reached the end of each endless day, I have to fight through the night to snatch a few hours of disturbed and broken sleep.

I feel like I held on to my last shred of sanity while I was in the hospital, because I was focused on the short-term goal of getting discharged and because a smoldering filament of rage kept me connected, somehow, to the outside world. But now I have no goals, no anger, nothing, I’m just drifting in a completely meaningless void while the world keeps moving around me.

This depression feels like a brain tumor that has been growing for six years, slowly at first but ever faster as the malignancy multiples, gradually taking up more and more space inside my head and slowly choking off pieces of who I am. It has strangulated my motivation, eroded my energy, killed my capacity for hope. All I am left with now – and for how much longer I don’t know – is the capacity for gratitude, and a raw and feral intelligence caught in a leg-hold trap, thrashing ferociously and trying to chew off its leg to escape but unable to gnaw through the bone. And this toxic neoplasia continues growing faster than my acceptance of it, an escalating arms race, a Cold War in my brain.There are no surgical options for treatment, no chemotherapy, not even any palliative means to ease this excruciating pain.

My psychiatrist, my sister, my friends – friends! such an inadequate word to describe these people that I love so fiercely – they encourage me so often to find things to be hopeful for. I try – I do – I try so hard – with infinite gratitude for their kindness and support – but I cannot manufacture authentic hope. It’s like being naked in a winter wind, trying to imagine what warmth feels like – even if you can conjure up the most vivid memory of hot summer sun, it will not prevent you from freezing to death.

I think the most powerful emotions are gratitude and hopelessness.They both have the ability to eclipse all semblance of rational thought. They both leave me breathless in the wake of their intensity. And the two can coexist in a devious kind of harmony, like brilliant fireworks bursting in an unrelenting darkness.

My parents have a small herd of Black Angus cows, small enough that they still name every calf born in the spring. Choosing names for the calves was always so much fun when we were children… until the year my younger sister named her steer calf Isabelle. I was shocked and horrified by her callous disregard for the unspoken but unquestioned rule that boys get boys’ names and girls get girls’ names, no matter what species of creature they are. I cried for a while, then tried to talk her out of such a ridiculous decision. But when she refused to change her mind, I promptly named my heifer calf John out of spite. So there, little sister.

It wasn’t until much later that I really started to question why our world divides first names into male and female, why we insist on saddling such innocent syllables with a gendered connotation. It began to feel so strange to hear expectant parents proudly recite two separate lists of possible names for their unborn baby, names for a girl and names for a boy, those two prenatal lists already hinting at a more sinister set of stereotypes settling into place while the fetal cells diligently divide and differentiate.

Had I been born with a tiny infant penis, a urethral ticket to a world of privilege, my name would have been Benjamin. Instead I was given the female name my parents found in a quiet grassy cemetery, my pregnant mother strolling with my father, visiting the graves of relatives, falling in love with my name on a headstone one row over. It is a beautiful lyrical name, it means “purple flower”, and it is so rare in North America that most online baby name databases do not even recognize its existence. It is a name that has garnered many compliments when I first introduce myself, a name that has been mispronounced a dozen different ways in a dozen different accents, a name that is more deeply and more permanently a part of me than a tattoo or a scar. I am neither proud of this name nor ashamed of it, I regard it with the neutral allegiance of 24 years of involuntary companionship. I withhold my name here only out of concern for privacy.

But as I explore the world of gender, I wonder if perhaps I have outgrown this name. Considering a name change comes with a confusing mixture of emotions: sadness about leaving one name behind, excitement at the prospect of choosing another, guilt that I am erasing the name my parents put so much love and thought into, fear that by choosing a male name I am simply reinforcing the gender binary that has been so damaging and restrictive my whole life. I want to make it clear that for me, gender dysphoria is an almost purely physical distress, centered around my body and the problematic anatomy that my brain resists so emphatically. For me, names and pronouns are merely a matter of semantics, relevant only to the extent that a stranger’s “sir” or “he” validates the masculinity of my physical appearance. The main reason I have considered changing my name is that, depending on the extent of my transition (which at this point remains uncertain), a female name will become confusingly incongruent with a male body in most public circumstances. Adopting a unisex or male name will make it simpler for me and for other people. Of course, the simplest thing is not always the right thing, so I continue to reflect on my motivations for choosing a new name. For many of my friends, my first name is irrelevant anyway, as they refer to me by my last name (McMurray) or by nicknames derived from my last name (mcmurr, Mac).

The list of names that I considered was drawn mostly from my favorite fictional characters: Peter (Pan), Jeremy (Finch), Dirk (Pitt), Owen (Meany), Jack (Reacher), Max (Rockatansky). But I kept circling back towards the name I used online for years before I even acknowledged transition as a possibility: Tom Sparrow. As a child I was intrigued by a story my parents told me about their wedding. They had a guestbook for guests to sign their name and record where they were visiting from. After the wedding, my parents found a signature in the book from someone they hadn’t actually invited, a Tom Sparrow from New York, New York. My dad suspected that his best man had written the pseudonym as a joke, but I always liked imagining that this itinerant stranger, Tom Sparrow, had actually crashed their wedding. And this story resonated deeply with my younger self because, like Tom Sparrow the wedding ghost, I so often felt like an invisible guest at someone else’s party. Tom Sparrow… the name was a quick little bird flitting restlessly through the thread of my thoughts. (I only recently found out that the name in the wedding guestbook was actually Todd Sparrow, I must have misheard it the first time my parents told the story, but it’s too late now because Tom has solidified in my mind over so many years).

So I tried using the name Tom in the few circumstances where people knew about my gender journey and did not already have a nickname for me. With one friend I started signing off my emails as Tom (thereafter double checking the name at the bottom of all my emails to avoid any awkward mistakes). I asked my psychiatrist to call me Tom. I introduced myself as Tom in therapy groups. The name Tom felt so strange and foreign in writing and out loud, so I gave myself nearly a year to get used to it. But the foreignness never waned and Tom continued sounding silly and contrived. Eventually – frightened by the mounting feeling of detachment from my name, frustrated by my continued uncertainty regarding transition, and struggling with severe depression related to other life circumstances – I stopped signing my emails to my friend and requested that my psychiatrist not call me any name at all. This namelessness was comforting initially, like the reassuring anonymity of a dial tone.

But namelessness was not sustainable forever, so I tried Thomas instead of Tom. And very quickly Thomas felt right. I’m not exactly sure why… perhaps the single syllable of Tom was too abrupt and harsh and Thomas has a softer sibilance, perhaps the formal tone of Thomas commanded more of my respect, perhaps I reached a more authentic acceptance of gender dysphoria and could then commit more fully to this aspect of transition, perhaps it was simply the passage of time and a thousand self-reflections that softened the shape of a new name.

So for now, I am Thomas, to myself (sometimes), to my psychiatrists, and to friends who don’t already have their own name for me – those cheerful nicknames that carry all the shared history of an ongoing friendship.

Thomas means “twin”, which has an appealing symmetrical symbolism. You see, I am twins in one body. I am two sexes, male and female – separated by time and perception, biology and convention – inevitably intertwined until death do us part.

“I know my name now. That’s some comfort.” – Alice (Through the Looking-Glass and What Alice Found There, 1871)

This gender journey is a constant hopscotch between the past, the present, and the future; where I was, who I am, what I want. The past is a jumbled collection of pieces from a dozen different puzzles and rummaging through it all – with the cold clarity of retrospect – has allowed me to start connecting those pieces into images that finally make more sense.

One of those old puzzle pieces comes floating up from time to time on the radio, leaping through the speakers with a smile and a wink – hello darling, didja miss me?

Somebody Told Me was released in 2004, the second official single from The Killers’ debut studio album Hot Fuss.

Well somebody told me That you had a boyfriendWho looked like a girlfriendThat I had in February of last yearIt’s not confidentialI’ve got potential –

I remember hearing this song so many times on the dusty bus ride to and from my junior high school. It became for me an anthem of potential, striking a chord that I could not then articulate. I was enchanted by the idea of a boyfriend who looked like a girlfriend, captivated by the aching naked androgyny in those lyrics, and I wondered – drawing circles in the dirt on the grimy school bus windows – if a girlfriend could ever, maybe, look like a boyfriend. And then the song would lean back down and taunt me with the possibility…

I said maybe, baby, pleaseBut I just don’t know nowWhen all I want to do is try –

Lately I have found myself quite often on the verge of coming out to my sisters and close friends about my gender dysphoria and transition considerations. Perhaps I feel like I owe them some honesty in return for their generous support while I was recently hospitalized for treatment of depression. Perhaps I feel an increasing urgency to share my fears and excitement with them as time ticks closer to the date of my appointment to discuss starting testosterone. Perhaps I have simply grown tired of constantly editing what I say and cropping out so much of myself around them that the prospect of finally dropping these pretences feels so incredibly enticing. I don’t know exactly why I feel this inner pressure to come out to certain people, but I must acknowledge that this pressure is strong and sometimes almost unbearable.

But even stronger than that pressure is a vague and deeply unsettling discomfort that has so far kept me from coming out to them. I have had many opportunities to tell them and I am reasonably confident that their responses will be supportive. But this mysterious reluctance always mutes the coming out speech that I’ve rehearsed so often in my mind. The only way I can describe it is that sharing my gender journey with anyone I haven’t already told feels like I’m losing control of my story, like my voice is getting drowned in an increasingly crowded conversation. Twice I have discussed my gender issues in a group (one a transgender support group and the other an interpersonal therapy group), and the group setting ramps up my discomfort to an extreme, like I’m not just losing control of my story but that the group members have actually stolen my rough draft and are busy making red-ink edits on words they barely understand. So I have inevitably withdrawn the gender topic from the groups that I’ve attended.

When I first started exploring gender identity and transition options more than 18 months ago, coming out to my closest friends felt so simple and natural, like taking a framed picture off the wall and revealing the hook that held it up – something that they had known must be there, even without seeing it, something unquestionably necessary to the suspension of that hanging frame, but which, when glimpsed for the first time, seemed stark and unexpected in an unsurprising way. With these friends, my gender journey is a constantly evolving conversation, not just one dramatic and irreversible leap out of the closet. I am continually amazed and grateful for their patient curiosity and acceptance. They allow me to explain my experience and explore my uncertainties, acknowledging the difficulties I encounter without claiming tritely to have “been there too” and without dismissing it as something so unusual and so weird that they “just can’t relate” – irritating responses that I’ve heard all too often from other people. These friends also allow the urgency and enormity of my gender issues to ebb and flow with time, accepting this process as a non-linear progression.

Sometimes with peripheral acquaintances, people I’ve just met or barely know, I come out to them quite quickly, almost carelessly, tossing this huge disclosure at them like a handful of nearly worthless coins, a defiant challenge to test whether this is something that might interfere with a budding friendship still in its fragile infancy, unwilling to invest the energy in developing a doomed relationship. This is maybe not the best approach, just a pattern I’ve noticed with myself.

I am most afraid of coming out to my parents. Because I am currently living at home with them, this fear prowls behind every familiar doorway in the house that I grew up in. One of my friends had an extremely traumatic experience coming out to his family many years ago – he said that when he came out to his parents, he did so very abruptly which may have contributed to their feeling shocked and overwhelmed, and he did so while struggling immensely with his own questions and uncertainties which may have facilitated their unfortunate belief that they could exert their parental influence to control his choices. So with my parents I have tried to approach coming out slowly and strategically, setting up several steps in advance and thinking several moves ahead, laying tentative groundwork for future possibilities, like a delicate chess match. I frequently bring up trans issues in the news and media to discuss with them, edging ever closer to the truth while keeping the discussion neutral and impersonal, referring to transgender people as “them” and not “us” – not yet.

On some level, I think my father already knows the truth. Over the past few years he has become much more open-minded and more tolerant, able to re-evaluate the many restrictive ideas his generation grew up believing. Since I was a kid he has always accepted and supported my obvious gender non-conformity. So I have played a gentle match with him, his Pawns relenting peacefully one by one, and his white King waiting in a patient stalemate while my dark Knights rein back heavy horses.

My mother has perhaps begun to suspect the truth as well, although her fear and prejudice slam the door on those suspicions and cut off any opportunity for reflection. I am often ashamed at the bitter depth of my resentment towards her, resentment built up by the years of hated dresses and ponytail hair she forced onto me, resentment maintained by the irrational childlike fear and guilt I still feel around her. With her I play a much more timid game, time and again caught off guard by her aggressive, reckless, unpredictable moves. But I have tried to practice being more assertive in our inconsequential daily duels, practicing for the inevitable big discussions. My front-line Pawns remain defensive, trying mostly just to minimize losses while they repeatedly withdraw and regroup before bravely inching forward once again, encroaching incrementally on her imposing Queen, until – eventually, explosively – checkmate, mother.

One of my friends – with his ever-sparkling insight – told me, “I know that I never felt ready to come out. It just sort of happened because the pressure and anguish of staying hidden just overwhelmed me and I fell out of the closet. I would trust your inner voice here… hopefully the time will feel right, or it won’t and you’ll just fall out of the closet and pick up the pieces and carry on.” His idea of falling out of the closet – as a necessity more than a choice – resonated so strongly with me. It is an eloquent description of how it has so often felt when I have discussed my gender journey with others. But I am working hard to give myself permission NOT to feel pressure to come out to anyone else right now, to keep writing my own rough draft, to be okay with falling out of the closet and picking up the pieces if that is the way it eventually has to happen.

“Fancy what a game of chess would be if all the chessman had passions and intellects, more or less small and cunning; if you were not only uncertain about your adversary’s men, but a little uncertain also about your own; if your Knight could shuffle himself on to a new square on the sly; if your Bishop, in disgust at your Castling, could wheedle your Pawns out of their places; and if your Pawns, hating you because they are Pawns, could make away from their appointed posts that you might get checkmate on a sudden. You might be the longest-headed of deductive reasoners, and yet you might be beaten by your own Pawns. You would be especially likely to be beaten, if you depended arrogantly on your mathematical imagination, and regarded your passionate pieces with contempt.”
– George Eliot (Felix Holt, the Radical, 1866)

I had coffee with a friend this week and we were both wearing long-sleeve shirts with the sleeves rolled up past the elbows and our forearms resting on the table fairly close together. And I could not stop looking at his arms, distracted to the point that I had to work really hard to follow the conversation and force myself to look up and make eye contact. There was just an excruciating… rightness… about the way his arms were put together, the heavy sturdiness of his wrists and knuckles, the forearm muscles bunched up just below the skin, the veins so stark and prominent (only men’s veins look that way, I’ve never seen it even in very lean and fit women), his tattoos somehow emphasizing all of those things even more. It wasn’t a conscious comparison, it wasn’t sexual or even aesthetic attraction, it was just a painfully heightened awareness of how completely right that body was and an overwhelming ache to live inside a body like that.

This is the same way I feel whenever I see men of similar age and similar physical build as me: my brother (especially when he walks around the house shirtless, that ache becomes a knife through my spine), one of the male construction workers in the cafe as I write this (the way his shirt snugs mockingly over broad masculine shoulders, the mesmerizing peak of his Adam’s apple bobbing as he laughs with his coworker, another knife through my spine), male squash players (god, how their bodies cut me to shreds!), random men walking down the street, narrow hips in jeans, square jaws, deep resonant voices, all slashing, slashing, slashing away at me all the time, the pain mixed with a vicarious pleasure in imagining what it would be like to live inside those bodies.

So of course, with all of that, how could I possibly consider transitioning to any point but “all the way”? How could I ever be satisfied with less than what those men look like?

But then. Sometimes I feel so incredibly at home in this body that I have, especially when I exercise, every movement a genderless fusion of form and function. Yesterday I ran on the treadmill for the first time in months, sprint intervals at maximum speed. I could see my reflection in the windows in front of the row of treadmills and somehow it didn’t bother me at all, because I felt such an effortless and elegant lightness in my running body – I felt the way my legs stretched with each stride and the contact of my feet on the belt and the expansion of my chest with every breath – and I was overwhelmed by a glittering fragile heartbreaking gratitude for this body.

And in that moment I wondered why I’m considering transition at all… the thought of injections and scalpels and drugs seems like such a gruesome fate for that graceful running girl, like seeing a cheetah stretched out mid-sprint on the savannah while imagining her body splayed open on a necropsy table, organs weighed and measured and her beautiful wild life reduced to blood glistening on stainless steel. Could I really do that to myself? But how can I deny the lifelong compulsion for physical masculinity that has driven me to near starvation and lingers like a spectre in every mirror image? This is the most perplexing and painful dichotomy…

“Who in the world am I? Ah, that’s the great puzzle!”– Alice (Alice’s Adventures in Wonderland, 1865)

Something I’ve noticed over the past few months is a shift in how I manage physical dysphoria. For the past five years, after gaining a lot of weight which accentuated my female anatomy, I coped almost exclusively though avoidance: showering in the dark, avoiding mirrors, deleting photos of myself, wearing baggy clothes, etc, basically pretending that my body didn’t exist.

But after a rigorous workout routine for the last 8 months, I have lost weight and built muscle and restored some of the physical androgyny that made me feel more comfortable as a scrawny teenager. I am able now to tolerate seeing my body or my reflection or my image in photos with less disgust. With this has come a shift from avoidance to compulsive body-checking and self-monitoring. Instead of avoiding mirrors, I now find it extremely difficult to pull my eyes away from my reflection.

This fascination (or perhaps obsession) seems motivated partly by simple astonishment and gratitude that I can actually tolerate seeing myself. But it is also motivated by a constant effort to reconcile that body as my own, which feels completely incomprehensible and beyond my power of imagination. The person I see in the mirror – the face, the body, the clothes – is all very familiar and recognizable, but in the detached non-self way that a close friend’s or sibling’s appearance is familiar and recognizable. When I see myself in a photo or in the mirror, I often notice myself thinking, “I suppose if I HAD to have a female body and could choose to look like someone, maybe it wouldn’t be so bad to look like her.” And then I remind myself that I DO look like her, that it’s actually ME in the mirror or the picture. But my mind remains unconvinced, and I continue to stare at those reflections and images of myself with the unsettling mixture of curiosity, frustration, and disorientation that comes with trying to unravel a particularly puzzling optical illusion.

The other part of this is that when I see my reflection or even just look down at my body, my appearance seems to change dramatically within the space of just a few minutes or hours. Sometimes it looks like I’ve gained 20lbs since morning and in my mind I immediately start making sweeping restrictive changes to my diet, only to see myself later in the day with the impression of almost unhealthy leanness and then erase all the dietary changes I just made.

More often it doesn’t look like weight gain or loss, it seems instead like a generalized skeletal reconfiguration, like all the ratios and proportions of my body (waist to hip ratio, width of my shoulders, angles of my face) have shifted to create subtle but – to me – obvious and unsettling differences in my appearance. My image remains familiar and recognizable, but constantly different, like looking in the mirror and seeing various digitally altered versions of your friend or sibling. Even when I mentally account for the differences in clothing, lighting, mirror distortion, etc, I can still see very clearly all the structural changes in my appearance.

This feels like a new experience that has emerged in the past few months, probably because it has been so long since I was actually able to see myself without immediate revulsion and withdrawal. Sometimes I feel like I’ve gone completely insane… I know with certainty that it is not physiologically or anatomically possible for any human body to change that much in such a short period of time. I know this. I remind myself of that over and over. Yet what I keep seeing with my own eyes, right there in front of me, incontrovertible visual evidence, is this shape-shifting mirror-ghost of a body that I cannot imagine I actually inhabit.

“What a strange thing a mirror is! And what a wondrous affinity exists between it and a man’s imagination!” – George MacDonald (Phantastes, 1858)